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Item Fostering Cultural Humility in Caring for a Returning Traveler: A Pediatric Resident Simulation(2022) Hecht, Shaina; Westwater, Molly; Sui, Htayni; Byrne, BobbiIntroduction: International travel has become more frequent outside of the current worldwide pandemic. With increased international travel, there is also more opportunity for physicians to encounter illness associated with this travel, including in pediatric patients. Pediatric residents should be well versed in obtaining a detailed travel history, creating a differential diagnosis and launching a treatment plan with the family for management of illness after international travel. Additionally, the concepts of cultural humility and avoiding judgement while caring for families with different cultural backgrounds is an important skill for residents to foster during training. Study Design/Hypothesis: A simulated patient encounter focusing on a pediatric patient with recent international travel was designed as part of a large multi-scenario simulation education event that is held annually for all pediatric residents. We hypothesized that this simulation would increase pediatric resident knowledge in obtaining a travel history as well as improve the residents’ self-perceived cultural humility when caring for international travelers. Methods: We designed a simulation scenario for second year pediatric residents focused on a febrile child who recently returned from international travel. The child’s family originally presented to a local religious leader prior to having the medical assessment. Pre and post simulation, a survey with questions regarding medical knowledge in the preparation of a pediatric patient for international travel as well as assessment of these patients upon return from international travel were included. Additionally, the Multidimensional Cultural Humility Scale (MCHS) was administered to residents to assess their cultural humility pre- and post- simulation. Results: Twenty- seven residents participated in the simulation. Overall, the mean score of the MCHS did not significantly increase after the simulation. After completing the scenario, all participants did agree that they felt more comfortable caring for immigrant children, more prepared to take a travel history, and more comfortable caring for a child who has traveled or will travel internationally. Conclusions: While we did not find statistical significance in overall self- perceived cultural humility after completing the simulation, pediatric residents felt more prepared to care for children after international travel as a result of participating in this educational intervention. Further data is required to determine if statistical significance would be achieved with increased numbers of participants. Based on post-scenario feedback and observations from scenario facilitators, minor adjustments will be made in future iterations of the scenario to better meet the educational objectives outlined for the participating pediatric residents.Item Investigating the Effectiveness of Case-Based Learning Sessions for Integrating Anatomy Content(2022-04-28) Merritt, Emily R.; McNulty, Margaret A.; Neal, Chemen M.; Deane, Andrew S.; Haywood, Antwion A.; Byram, Jessica N.Introduction: Adjusting to medical school can be challenging as students learn to adapt to the curriculum’s fast pace and content volume. Gross anatomy, embryology, and histology are increasingly integrated into medical curricula, with the responsibility placed on students to find and understand the relationships between these content areas. Case-based learning (CBL) is an effective and commonly used means of teaching in medical education, and its application of problem-solving skills to clinical cases make it a useful method for integrating content. Study Objective: Therefore, the goal of this research was to assess the effectiveness and value of CBL sessions in integrating gross anatomy, embryology, and histology and promoting effective study techniques. Methods: In 2021, Indiana University School of Medicine implemented a pre-matriculation program (termed “Leadership and Academic Development”, or LEAD, Scholars) targeted toward under-represented students in medicine. The program included content from the first block of the medical anatomy course and four fully integrated CBL sessions that each included anatomy, embryology, and histology content from the upper extremity and thorax. LEAD Scholars (n = 25) were divided into groups of six or seven; for each session, they completed an individual pre- and post-quiz and worked as a group to answer case questions. Cases consisted of one or more clinical scenarios and questions that required students to interpret images, complete matching exercises, and make diagrams or flow charts. Students completed a post-session survey with Likert-style questions and free responses about preparation and session effectiveness. Pre- and post-quiz scores were compared using Wilcoxon signed rank tests. Free responses were analyzed using thematic analysis. Results: Analyses revealed a significant improvement on post-quiz scores for all CBLs (p≤0.002). In the post-session survey, students strongly agreed the sessions were effective at improving their understanding of course content and appropriately connecting anatomy, embryology, and histology content. Students commented that they enjoyed the real-life application of the material, found the sessions helpful for making connections between the topic areas, and encouraged them to keep up with the material. They noted that adding more cases and providing more pre-work to guide preparations would improve the sessions. Students also discussed needing to change their study habits as the sessions progressed and noted difficulty in keeping up with the embryology and histology content in light of the volume of gross anatomy material. Conclusion: These results suggest that CBL sessions are a viable means for delivering integrated medical anatomy content to medical students and providing opportunities to practice and adapt study techniques. Session modifications will focus on expanding the sessions to provide more opportunities to practice the content and study techniques and including specific pre-work activities to guide preparation.Item Career Mentors & 5-Year Data on the IUSM Anesthesiology Match(2022-04-28) Yu, Corinna; Ye, Jian; Boyer, Tanna; Mitchell, SallyIntroduction: The IU Department of Anesthesia provides Anesthesiology Career Mentors to 3rd and 4th year medical students. We have approximately 47 requests per class year. In the past 5 years, we have matched 181 students into Anesthesiology, averaging 36 students per year (range 30-46). Where do these students match into Anesthesiology? How many of them use the Career Mentorship program? If they don’t choose Anesthesiology, which other specialties appeal to them? Objective: The purpose of this presentation is to examine the pipeline of students interested in anesthesiology who request a career mentor and match into anesthesiology. Methods: Match data from publicly obtained IUSM Graduation Booklets for the Class of 2017 through 2021 was filtered for those students matching into Anesthesiology Residency Programs. These programs were mapped and cross-referenced for medical school rankings based on the 2022 US News & World Report Medical School Rankings for Research. Anesthesiology career mentorship requests were tracked starting in 2019 for the class of 2020 onwards, so students who matched into Anesthesiology were cross-referenced with students who had formally requested Anesthesiology Career Mentors in 2020 and 2021. Students who had formally requested Anesthesiology Career Mentors in 2020 and 2021 were also cross-referenced with the IUSM Graduation Booklet data to see how many of these students matched into Anesthesiology or other fields. Results: Of the 181 students that have matched into Anesthesiology from 2017-2021, 63 students matched at IU (35%). The rest are distributed across the regions of the US, including residency programs at the top 25 medical schools including Harvard, NYU, Duke, Stanford, and UCSF. The majority of students matching into Anesthesiology request Anesthesiology Career Mentors, with 73% (48/66) of students assigned to mentors in the graduating class of 2020 and 2021. 96 mentors were requested in the class of 2020 and 2021, with 29 students (30%) not matching into Anesthesiology. These students may have changed careers and not applied to Anesthesiology. Many of these students choose to pursue other specialties, including Internal Medicine, Radiology, Pediatrics, Family Medicine, General Surgery, Obstetrics-Gynecology, Orthopedic Surgery, and Psychiatry. Some students were not listed in the IUSM Graduation Booklet or did not have a residency listed. Conclusion: Limitations of this analysis include students’ choice to publish their Match data in the IUSM Graduation Booklet and the possibility of some students being lost to follow up due to not graduating yet or changing their name. No direct link can be made between formally assigned Anesthesiology Career Mentors and the Match, especially since some students may have sought out informal mentorship. Anesthesiology continues to be a competitive field with high student interest. More research can be done to understand factors that influence student decisions for specialty and to track student alumni and follow their career progression into fellowship and the physician workforce. Additional data collection on the usefulness of the career mentorship program and ways to improve and further support student career choice and Match success will be especially helpful as Step 1 changes to pass/fail.Item Medical Student Concerns for Respiratory Protection on Anesthesiology Elective(2022-04-28) Yu, Corinna; Webb, Timothy; Guillaud, Daniel; Mitchell, SallyIntroduction: Anesthesiologists perform aerosolizing procedures including endotracheal intubation, necessitating the use of personal protective equipment (PPE) such as N95 masks during the Coronavirus Pandemic. Medical students rotating on anesthesiology electives are similarly exposed to potential viral transmission during these procedures. Objective: This study compares student responses to concerns about their respiratory protection in 2020 vs. 2021. Methods: Medical students rotating on the Adult Anesthesia Elective (2020) and the Anesthesiology & Perioperative Medicine Elective (2021) were assigned to read, “Respiratory Protection for Healthcare Workers” and answer “Do you have any concerns about your respiratory protection?” 61 students completed the assignment in 2020, and 74 students in 2021. These responses were analyzed and coded for themes. 10 themes emerged for students who were concerned with their respiratory protection, and 4 themes emerged for students who were not concerned. Basic percentages were calculated and the number of students expressing various themes in their responses was summed and compared between 2020 vs. 2021. Results: In 2020, 35% of students were concerned about their respiratory protection, decreasing to 28% in 2021. Reasons for students not being concerned include the availability of PPE, vaccination status, testing patients for COVID pre-operatively, and the option to avoid the risk. Reasons for concern included the aerosol-generating nature of intubation, N95 masks should be single use, patients not being tested for COVID properly and failed fit tests and mask seals (only in 2020), availability of PPE, fear of being a vector, and not doffing properly. Long-term COVID complications and ability to socially distance at work were also concerns in 2020. Conclusion: Student concern with respiratory protection decreased from 35% to 28% from 2020 to 2021. One of the primary differences is that students were vaccinated in 2021. Students not concerned displayed confidence in PPE availability and patients testing negative for COVID-19 prior to OR procedures. In addition, some students commented on their ability to avoid risk by not caring for COVID-positive patients, although one student commented this hindered their education. Student concerns included viral transmission during aerosolizing procedures and the observation of N95 mask reuse, which is not advised. Some students were not able to get a fit test due to PPE shortages or had failed their fit test in 2020. Facial hair and having a beard was a concern in both 2020 and 2021 for proper mask fit. Other students feared being an asymptomatic carrier and acting as a vector to their patients and loved ones. Similarly, they worried that the testing window for patients was too wide. Students in both 2020 and 2021 expressed concern about self-contamination from not doffing their PPE properly. A few students commented on the unknown long-term effects of COVID-19 and the inability to socially distance at work. Generally, students were not concerned with PPE availability and their personal safety in the clinical environment on their anesthesiology elective. As the pandemic continues to evolve, time will tell if we can continue to maintain PPE supplies, effective vaccines, and work to decrease student concerns.Item Parental Leave During Anesthesiology Fellowship(2022-04-28) Rigueiro, Frank; Yu, CorinnaIntroduction: Parental leave is an important consideration for many residents and fellows as they choose programs balancing their career goals with their goals for family planning. Benefits of parental leave are decreased infant mortality and increased breastfeeding, which has health benefits for infants and mothers. In 2018, one study found only 7 of 15 residency training institutions in the local area had an institutional GME policy providing paid designated childbearing leave. A study at Mayo Clinic at 269 programs found that 40% of residents and fellows planned to have children during training. 89% of fathers rated parental leave as an important benefit, and pregnancy and childbirth plans altered choice of GME program in women more often than in men. The ACGME encourages allowances for parental leave but does not provide specific recommendations on how to manage the leave, giving programs institutional control over their own policy. Leave policies can be complicated by requirements from Centers for Medicare and Medicaid Services, Health Resources and Services Administration, the Veterans Health Administration, and the National Institutes of Health, depending on allocations for resident/fellow salary. Objective: As prospective anesthesiology fellows research programs with family planning in mind, how accessible are these local GME policies on parental leave? Methods: We compiled a list of all 140 ACGME-approved anesthesiology fellowship programs including 60 pediatric, 74 adult cardiothoracic, 63 critical care, 39 regional and acute pain medicine, 41 obstetric, 111 chronic pain medicine & 1 clinical informatic program. We performed online searches of each program’s website to look for institutional GME policies on parental leave. If we could not find the results within 10 minutes, it was considered not easily accessible. Results: Out of 140 anesthesiology ACGME-approved fellowship programs, 99 programs had parental leave policies easily accessible online (71%) whereas 41 programs did not have policies easily accessible online (29%). Of these 41 programs, 6 of them required a log-in for access to their parental leave policies. Discussion: Anesthesiology fellowship programs should consider having a generous parental leave policy and making this policy easily accessible online to demonstrate support for physician well-being and work-life balance. We found that many anesthesiology fellowship programs do not have parental leave policies easily accessible online for interested applicants. Reasons many trainees don’t use parental leave include the sense of being a burden to colleagues, anticipation of a heavier workload later, delayed program completion, not needing the time, or not being the primary caregiver. Additional research should pursue opportunities for competency-based training, flexible scheduling of work hours or start dates, part-time options, and childcare benefits to meet the rising demands of the current workforce. Conclusion: Parental leave is an important public health priority and an important aspect to physician well-being. Residency and fellowship programs should ensure they have established institutional GME policies and share them publicly in an easily accessible format online with interested applicants to remain competitive and guarantee a diverse applicant pool.Item A Simulation Case of Cricothyrotomy in an Acute Upper GI Bleed(2022-04-28) Yu, Corinna; Rigueiro, Frank; Backfish-White, Kevin; Boyer, TannaIntroduction: Although difficult airway management is an expected skill of anesthesiologists, there is no mandatory training focused on this skill set in anesthesiology residency programs. Difficult airways are taught when the clinical situation arises, leading to variable resident expertise. Formal instruction in cricothyrotomy is lacking and the procedure is clinically rare. This lack of training has led to a rise in fellowship programs in airway management, demonstrating the need for greater attention to this skill set. Procedural times for cricothyrotomy improve after educational interventions, providing further evidence to support formal instruction in invasive airway management training. Patients presenting for upper endoscopies are considered full stomach due to the bleeding, and endotracheal intubation is preferred over sedation to prevent aspiration. These airways can be challenging to manage and may require surgical intervention as a last resort. We created a difficult airway simulation scenario to teach residents cricothyrotomy. Objective: To teach anesthesiology residents how to perform a cricothyrotomy and improve their confidence in difficult airway management. Methods: A patient presents with an acute gastrointestinal bleed for an upper endoscopy. A pressurized bag of red fluid was hidden out of view with tubing placed into the SimMan’s posterior oropharynx. Anesthesiology residents obtain the history from the patient when the patient coughs vigorously and its mouth fills with simulated blood. Residents attempt intubation, which is difficult if not impossible on this SimMan. When they communicate their decision for surgical intervention, a secondary mannequin was provided to perform the actual cricothyrotomy. At the end of the simulation, a behavior checklist is used for evaluation and the residents are asked to complete a simulation feedback form. Results: 26 PGY-4 anesthesiology residents completed the simulation from April-May in 2019 with 25 residents providing feedback with a 5-point Likert scale of agreement. Most residents quickly recognized the patient’s need for emergency intubation. 16 residents had prior experience managing the airway in an acute upper GI bleed (average 3 patients) whereas 9 residents reported no prior experience. 88% of participants strongly agreed that the simulation was a valuable learning experience with 92% stating it increased their confidence and clinical decision making in handling similar scenarios in the future. In addition, there were no negative scores to any of the survey questions. Discussion: Difficult airway skills include management of a patient with an upper gastrointestinal bleed requiring surgical cricothyrotomy. This is a valuable skill that can be taught with simulation. Our simulation led to an increase in resident confidence in the procedure, but it would be useful to follow up with the cohort and see if these skills prepared them for patient encounters afterwards and if the learning was sustainable. Conclusion: Our simulation case was a valuable learning experience for residents and provided critical surgical skills for future anesthesiologists in difficult airway management. It is worthwhile to include this simulation in the anesthesiology resident curriculum.Item Scholarly Concentrations Program: A PRIME Approach to Addressing Care for the Medically Underserved and Vulnerable Populations(2022-04-28) Birnbaum, Deborah R.; Rojas, Michelle; Allen, Bradley L.; Wallach, Paul M.Examine how well the structure of the Scholarly Concentrations Program and content of each concentration relates to the goals of the federal Health Resources and Services Administration grant received to create more interest and prepare more medical school graduates to care for medically underserved and vulnerable populations. The grant funds the Primary Care Reaffirmation for Indiana Medical Education, or PRIME. project. A review of how concentrations align with the grant was conducted by reviewing program, concentration and course learning objectives and mapping to the grant objectives. Numerous concentrations were found to be an excellent fit, creating a PRIME opportunity to enhance the SC Program and move the needle on the grant objectives.Item Pre-Clinical Medical Students' Attitudes Towards Psychiatry(2022-05) Opperman, Michael; Smith, Alyssa; McCann, Joseph; Chastain, Jonathan; Schiller, Brennan; Thomas, Alexander; Jivens, Morgan; Schargorodsky, David; Scofield, David; Grant, Larrilyn; Sweazey, Robert; Richardson, Jenelle; Plawecki, MartinItem Developing Cross-Cultural Empathy through Mindfulness(2022-04-28) Blazin, Lindsay J.; LaMotte, Julia E.INTRODUCTION: The murder of George Floyd sparked international movements to address racial inequality. These movements have prompted critical conversations about medical racism, bias, and social determinants of health. These events have caused us to turn inwardly and question what we know, the limits of our understanding, and the role of medical training in developing the skills and perspectives needed to address racial inequality in health care systems. The purpose of this session is to share the design and preliminary outcomes of a curricular intervention that aims to train pediatrics residents to use mindful reflective practice to develop cross-cultural empathy and engage with anti-racist ideas. STUDY OBJECTIVE: To develop and implement a curriculum that teaches mindful reflective practice as a tool for developing cross-cultural empathy and advancing diversity, equity, inclusion, and justice in healthcare. METHODS: Pediatrics and combined medicine-pediatrics residents participated in four 90-minute small group sessions: (1) cultivating critical awareness of racism in medicine, (2) unpacking bias, microaggressions, and coded language, (3) exploring personal identity and intersectionality, and (4) committing to action and curriculum reflections/feedback. Each session was co-led by 3 facilitators (LB, JL, FW) and structured to provide opportunities for learners to engage, explore, explain, and elaborate on the content presented. Each session began with a guided mindfulness activity and concluded with individual written reflection. Participants completed the Maslach Burnout Inventory, Mindful Attention Awareness Scale, Empathy Quotient, and Stanford Professional Fulfillment assessments prior to session 1, following session 4, and 3 months after completion of the curriculum. Participants also completed the Social Justice and Empathy Assessment following session 4, and 3 months post-curriculum. Quantitative data was analyzed for pre-post changes using t-tests. Curriculum acceptability, facilitator effectiveness, and perceived benefit of each portion of session content was reviewed. Participants engaged in a brief audio-recorded focus group at the end of session 4. The transcribed focus groups and participants’ written reflections following each session were qualitatively analyzed to identify common themes. RESULTS: Preliminary results from first two cohorts (N=9) indicate that all residents found the course to be sufficiently challenging and that it helped them to pursue growth. The majority of participants expressed increased understanding of curriculum domains; mindfulness (77.8%), medical racism (88.9%), bias/coded language/microaggressions (100%), and identity/oppression/intersectionality (88.9%) and rated the overall course as excellent (88.9%). All residents endorsed agreement for facilitator’s content expertise and excellence in teaching skills. Qualitative analysis of focus groups is ongoing at this time. Preliminary review suggests that participants enjoyed the curriculum, found it to be unique in their residency experience, and desire more opportunities to discuss DEIJ issues in small groups. We expect full quantitative an qualitative analysis of all 6 cohorts in this pilot study will be completed and available for presentation at IU Education Day.Item Formula Mixing Knowledge of Pediatric Residents at a Quaternary Care Center(2022-04-28) Andrewski, ErikPediatric residents receive a paucity of training in regards to best practices for formula mixing and storage leading to decreased comfort and discussion regarding formula at well-child checks. 18% of infants are never offered breast milk and over half of infants are receiving formula by 3 months of age. A large majority of parents report they received no guidance about formula mixing from healthcare providers and may be afraid to ask questions related to formula due to a significant culture of “formula shaming”. Complications of improper mixing include electrolyte abnormalities, hypo or hyperglycemia and failure to thrive. Resident knowledge regarding formula best practices was assessed and found to be deficient for both storage and mixing. A self-paced educational module was created to help residents improve their knowledge of infant formula use.